CEO SUMMARY: Participation in the development and implementation of Central Florida’s nascent regional health information organization (RHIO) is helping Clinical Pathology Laboratories (CPL), of Austin, Texas, achieve four strategic goals. Philip Chen, M.D., Ph.D., CPL’s Vice President and Chief Medical Informatics Officer, predicts that this RHIO will speed up the integration of healthcare informatics.
REMEMBER CHINs? DURING THE 1990s, Community Health Information Networks were the first attempt to create a centralized regional health database that could be accessed by hospitals, physicians, other providers, and payers.
Now the acronym de jour is RHIO, which stands for Regional Health Information Network. RHIO describes the current generation of attempts to create a useful database of health information that can serve all healthcare stakeholders.
Seven Counties Involved
Because any healthcare data repository will hold a large amount of laboratory test data, it is important for regional laboratories to participate in the development and operation of their local RHIOs. In Florida, pathologist Philip Chen, M.D., Ph.D., was recently selected to be on the board of directors of the Central Florida Regional Health Information Organization (CF-RHIO) in Orlando. This RHIO serves seven counties in the Orlando metropolitan area.
Chen is Vice President and Chief Medical Informatics Officer for Clinical Pathology Laboratories. Inc. (CPL), of Austin, Texas. He founded Cognoscenti Health Institute in Orlando, which CPL acquired earlier this year. (See TDR, September 4, 2006.)
“My involvement with the CF-RHIO serves four significant and strategic goals for our lab,” observed Chen. “First, participating in this project helps us understand the specific ways that healthcare IT will evolve in our community. This gives us a leg up in our own strategic planning. It helps us align our lab’s IT infrastructure to better meet the needs of the community we serve.
“Second, participating in the RHIO helps us stay in the forefront of medicine,” he added. “Our physician clients trust us and look to us to guide their own IT strategy development. What’s more, appropriate connectivity to clients improves service and leads to more secure and long-term client relationships.
“Third, participation gives our lab’s executive team direct access to key stakeholders in healthcare, such as other physicians, insurers, large employers, health system executives, community leaders, and government policymakers,” he explained. “We can use this access to share and educate our colleagues and partners in healthcare on the delivery of lab medicine and the importance of laboratory services.
Lab’s Place At The Table
“These days, attempts at healthcare reform and changes in reimbursement policy are being considered almost constantly,” said Chen. “That makes it important for laboratory executives to be heard in the decision making process. Being involved in the RHIO means we are included in discussions about exclusive lab arrangements, competitive bidding, preventive screening, reimbursement policy revisions, utilization management, and pay for performance, just to name a few strategic topics.
“The fourth benefit of participating may be the most important reason,” Chen said. “It helps us provide better care to our patients by weaving our laboratory more closely into the RHIO infrastructure. This ensures our ability to feed clinical data into the regional data repository. It also gives us access to relevant data about the patients and physicians we serve.
Risk Of Market Exclusion
“I am convinced that participation in the local RHIO is an absolute necessity in the current competitive environment in the marketplace,” declared Chen. “If we don’t participate in some way, eventually the role of laboratory medicine could be de-emphasized. That is why the participation of pathologists in these types of regional collaborations is essential.
“Laboratory test results affect 70% of medical decision making,” continued Chen. “All inpatient visits include laboratory testing, and greater than 70% of outpatient visits include lab testing. Laboratory data constitute the largest objective patient data set used in healthcare today. Clearly, all labs have a responsibility to support RHIO development.
“RHIOs are an important step in integration of the healthcare continuum,” he added. “It is logical for laboratories to play important roles in the development and operation of RHIOs.
“For CPL, participating in the development of Central Florida’s RHIO is not about positioning our lab for the future,” he said. “It’s about positioning CPL for the state of the healthcare marketplace today.
“Florida is a hotbed for RHIO development,” noted Chen. “At this time, there are five major RHIOs under development, along with several smaller rural projects. Outside of Florida, a number of RHIOs are being developed.
“Because the RHIO trend is still in its earliest phases, it is too early to predict what type of common organizational model will emerge,” said Chen. “However, the phrase, ‘No RHIOs are alike!’ seems to be generally accepted. Some are more advanced in technology development and implementation, particularly those in Cincinnati and Indiana. Other RHIO projects are more active in building infrastructure and developing governance.
“The Central Florida RHIO effort is likely to make a major impact on the laboratory industry when it comes to utilization,” predicted Chen. “One large insurance company here has reported that its claims data shows that the laboratory utilization rate in our state is 270% higher than the national average! For that reason, one of the first demonstration projects of the Central Florida RHIO is to analyze lab usage rates in Florida for appropriateness.”
Employers Took The Lead
But the Central Florida RHIO is significant for other reasons. “The Florida Health Care Coalition (FHCC) took the lead in developing this RHIO. Its employer-members in Central and Southeast Florida represent two million employees and spend several billion dollars per year on healthcare for their workers. As a result, FHCC was able to convince all stakeholders to participate in the RHIO. It’s unusual for employers to have so much clout in a market.”
THE DARK REPORT observes that the development of RHIOs across the nation will be a significant development—not just for the laboratory industry, but for all types of healthcare providers. Therefore, as Chen points out, it is essential for pathologists and lab managers to be involved in their communities’ RHIO development and operation. Such participation will ensure that clinical laboratories have a place at the table and can maintain strong relationships with their client physicians.
Still a Limited Number of RHIOs in the United States
REGIONAL HEALTH INFORMATION ORGANIGIONS (RHIOS) require the collaboration of a wide variety of stakeholders to allow physicians, hospitals, laboratories, pharmacies, and other providers to share patients’ medical information at any time and in any setting.
Forrester Research, a technology research group in Cambridge, Massachusetts, states that RHIOs are expected to improve the quality of care, and avert medical errors. RHIOs should also help to lower healthcare costs by eliminating redundant diagnostic procedures, preventing complications, shortening delays waiting for paper charts, and reducing other inefficiencies.
In a report released earlier this year, Forrester said RHIOs are in their formative stages. It found seven small regional networks in operation and wide variability in architecture and governance models. “The rest of the country will follow, but more slowly than advocates expect, as
stakeholders cast about to find the hundreds of millions of dollars needed to build a national network,” Forrester said.
Central Florida RHIO in Development
ORGANIZERS OF THE CENTRAL FLORIDA RHIO have one primary goal: to enable healthcare providers to access patients’ clinical information from a central portal.
“Other goals are to improve the quality of care, reduce medical errors, and boost efficiency,” stated Philip Chen, M.D., Vice President and Chief Medical Informatics Officer for Clinical Pathology Laboratories (CPL), of Austin, Texas. Chen is also a director of the Central Florida RHIO (CF-RHIO).
Currently, CF-RHIO includes representatives from 40 organizations, including area hospitals, physicians, medical laboratories, public health providers, insurers, higher education, and local businesses. The RHIO is part of the National Health Information (NHI) Infrastructure initiative to interconnect clinicians, so they can learn about a patient’s medical and medication history and make better treatment decisions. Over the next five years, CF-RHIO hopes to allow physicians and hospitals to access data created by clinicians anywhere in the country.